Training Nurses – Building Confidence and Cohesion

Nurse Educator Brianna Bonner remembers chatting with a newly graduated nurse one day and being a bit stunned by what she heard.

"She said that even though she was graduating from her nursing program, she didn't feel like a real nurse," Brianna recalls. "Nurses are nervous about getting started. It takes a while to gain experience and knowledge before you feel, 'I see myself as a full-fledged, competent nurse.'"

That emotional conversation, coupled with some of her own experiences at LVMC, inspired her to propose a "new nurse residency program," which has been underway for more than six months. The idea helps on two fronts – many hospitals, including LVMC, have difficulty finding enough nurses to hire. For the new nurses, it may be challenging to find a job with no real-world experience.

One of those new nurses, Katherine Schoellenbach, lived in the Bay Area after earning her RN at the City College of San Francisco. She finished nursing school in December 2020 and earned her Bachelor of Science in Nursing at Cal State East Bay. It is often difficult, she said, for new nurses to find jobs in California.

"I was excited about having more support and training as a new grad," she said. "It's such a big jump to go from nursing school to actually working. Right out of school, I did work at a quarantine hotel for people with COVID, and even though I loved the job, I also felt like I wasn't getting the support and learning opportunities."

New LVMC nurse Hannah Arnush earned an Associate Degree in Nursing from Santa Monica College, graduating in the fall of 2020. The San Fernando Valley native passed her nursing boards and received her RN license in June 2021. She's working on a BSN via Cal State Dominguez Hills.

"I am really enjoying the new grad program and have learned so much in the short time since I have been hired," Hannah said. "I love that the hospital has a tight-knit community with supportive staff. I am really grateful for all of the educational opportunities LVMC is offering. The training helps build on skills and teaches best practices that are in line with LVMC's policies and procedures."

When the program was announced, the hospital received about 45 applications from throughout the western US. Of those, 12 positions were filled.

When she started as a new nurse, Brianna said it would have been helpful to have additional education and support throughout her early months. With that background, she laid out the plan for the 12-month residency program.

"When I initially worked here at LVMC as a new grad, I floated to a lot of different departments within the hospital," explains Brianna. She holds a Master of Science degree in Nursing. "You get a unique experience in each department. It helps you gain that experience and connections with other departments as a whole."

She figured that having new nurses do rotations in various departments would help them gain additional skills and learn skills they might not get to develop within their "home" departments.

"It helps the department be more cohesive," she adds.

The nurse residents start their training in the medical-surgical department for about eight weeks, including classroom coursework. The nurses will then orient in one of the hospital's clinical departments, including critical care, surgery, emergency, labor, and delivery. Eventually, they'll choose a "home" department.

Each new nurse is paired with an experienced preceptor to help guide them through the year.

"They're slowly given larger patient assignments, and the preceptor is right by their side, looking over their charting, ensuring patient safety," Brianna said. "After that training, we put them with a mentor who is a focal point they can go to and ask questions."
Hannah was paired with RN Angela Johnson, whom she calls "strong, supportive and a wise nurse."

"I feel confident while working with her, and she is helping me adapt to the role as a nurse," Hannah said. "Angela takes the time to teach me new skills and walk me through any skill step-by-step that I have never performed."

The new nurses will also earn certifications such as Advanced Cardiac Life Support, National Institute Stroke Scale, and Neonatal Resuscitation Program during the program.

Brianna says the program allows nurses to grow in their careers and support reaching long-term goals. Because of the smaller hospital structure, new nurses may get assigned desired shifts or go into a department such as labor and delivery much quicker than they'd be able to at a larger hospital.

"For our hospital, this program means we will have stronger nurses right off the bat," Brianna says. "They'll have additional support and training throughout the program. They'll be more competent and prepared to handle complex patient issues. They'll have more exposure to all the different departments and greater awareness of how the hospital works. It's important, especially with a smaller hospital, to see the big picture."

Hannah's goal is to specialize in the Critical Care Unit and eventually work in the Emergency Department. Someday, she said, she might want to work in case management.

"The great thing about the hospital is that I have the opportunity to branch out down the line if I want to," Hannah said. "I believe that working on different units will help me become a well-rounded nurse. I plan on staying at LVMC for a while because I enjoy the work atmosphere and the staff. I like that I don't have to commute far for work, which wasn't an option in Los Angeles. At LVMC, there are many opportunities for learning and growth that I might not be able to get in a larger hospital."

Being in the residency program allows Katherine to develop her critical thinking and enhance her nursing skills.

"I want to get experience while also having support so that I can develop my intuition and judgment," she explains.

Ultimately, Brianna is hopeful the program will keep nurses at LVMC for a more extended amount of time.

"With more support, it makes them better nurses," she added.

Now that the LVMC program is underway, the Comprehensive Care Center is also starting a similar endeavor for Licensed Vocational Nurses and Registered Nurses. It is also a 12-month program at the skilled nursing and post-acute rehabilitation facility.

"The CCC's residency program will allow newly graduated nurses to make the transition from student nurse to working nurse seamless," said CCC Administrator Lorraine Jones. "We offer new nurses the ability to be fostered into the role of nurse by having a mentor throughout the orientation, as well as a clinical advisor upon hire."